Sunday, June 16, 2013

What makes a good checklist versus a bad checklist?What are the limits in the power of a
checklist?Sure, checklists work for the
weekly run to the grocery store or packing before we go on vacation but can
they work to reduce errors in surgery?

The answers to these questions and more can be found in the
fascinating book, The Checklist Manifesto by acclaimed writer and surgeon Atul
Gawande.This book is filled with a
series of stories from hospital settings to piloting airplanes that makes a
compelling argument that using well developed checklists can produce a
significant impact on performance success and eliminate errors.Facing ever-growing complexity in our lives
and workplaces along with pressures to get things right the first time,
checklists may prove to be a simple yet valuable tool in our error-proofing
approach.

The final results of a World Health Organization initiative
which is the core study described in this book “showed that the rate of major complications for surgical patients in
all eight hospitals fell by 36 percent after the introduction of the
checklist.Deaths fell 47 percent.
Overall, in this group of nearly 4,000 patients, 435 would have been expected
to develop serious complications based on our earlier observation data. But
instead just 277 did.Using the
checklist had spared more than 150 people from harm-and 27 of them from death.”These results are exciting and hopeful in
the quest for improved patient outcomes but it should be clearly understood
that the use of checklists is not described as the complete solution to the
problem.It is just a simple one that
appears to make a significant impact.

The Checklist Manifesto is extremely well written that draws
the reader along the journey of the author in exploring the power of
checklists.I found the stories
interesting and hopeful that the simple checklist might work surprisingly well
which the evidence seems to support in this book.

This book is not a “How-to-do-it” type book however it
provides some helpful suggestions in creating useful checklists.For example, good checklist are designed to
only provide critical reminders, practical, precise, easy to use and short and
most of all, ones that are used consistently.In addition, it will take some experimentation and collaboration with
the users to develop a good checklist so expect to try out several variations
until you create a checklist that works well.

For more details on building a better checklist, read the chapter
The Checklist Factory in which Atul learns about how to create a great
checklist from his field trip to Boeing’s “Checklist Factory” under the
guidance of uberchecklist master, Daniel Boorman.I found it fascinating and it opened my eyes
to just how difficult it is to create a really good checklist.

The most significant and insightful observation in this book
is the use of checklist as a team activity to enhance communication as a team,
to simply talk to each other and coordinate our activities at critical points
in the process. Dr. Atul Gawande writes:

“But like builders, we
tried to encompass the simple to the complex, with several narrowly specified
checks to ensure stupid stuff isn’t missed (antibiotics, allergies the wrong
patient) and a few communication checks to ensure people work as a team to
recognize the many other potential traps and subtleties.”

And finally, as we know from our lean and six sigma work, it is not easy to
influence culture change, promote new behaviors and sustain improvements, just
as the author found in trying to influence surgeons to use checklists. Dr. Atul
Gawande writes:

"...using the checklist involved a major
cultural change, as well - a shift in authority, responsibility and
expectations about care"

As
organizations, are we ready and able for a shift in authority, responsibility
and expectations for success?Do we
still cling to the illusion of superior lone superstar status or are we ready
to humbly work as a member of a well coordinated and trained team?

I enthusiastically recommend this book to all!This book is easy to read, short and a
fascinating story of battling complexity with a simple checklist. The Checklist
Manifesto is a must read for anybody working on continuous improvement and
reducing errors in any process.

About Me

Welcome to "Got Boondoggle?" My lean journey began over 20 years ago with a jump in the water and start swimming approach. By trial and error along with some great lean teachers, I successfully implemented the lean approach in a variety of businesses. My lean experiences include learning directly from the original lean leaders including Dr. Shigeo Shingo. As a certified Six Sigma Black Belt, I believe quality is a cornerstone of all improvement actions. By sharing these experiences and insights, my hope is that you may benefit on your lean journey.